Provider Demographics
NPI:1376578310
Name:AJIT V PAI MD
Entity Type:Organization
Organization Name:AJIT V PAI MD
Other - Org Name:PAIN MANAGEMENT GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJIT
Authorized Official - Middle Name:V
Authorized Official - Last Name:PAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-251-0498
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-0126
Mailing Address - Country:US
Mailing Address - Phone:574-968-2128
Mailing Address - Fax:574-807-8254
Practice Address - Street 1:3212 HICKORY RD
Practice Address - Street 2:SUITE B
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8862
Practice Address - Country:US
Practice Address - Phone:574-251-0498
Practice Address - Fax:574-251-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028758A174400000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherTAX EIN
IN228750Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER